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General NPI Number Information
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NPI Number | 1093672180
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Entity Type | Organization
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Legal Business Name | ANTIQUE GARDENS SENIOR CARE LLC
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Dates
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Enumeration Date | 01/08/2026
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Last Update Date | 01/08/2026
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Provider Practice Location Address
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Address Line | 6617 76TH AVE N
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City | BROOKLYN PARK
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State | MN
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Zip | 55428-1435
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Country | US
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Telephone | 763-260-7298
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Fax | 612-484-4413
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Provider Business Mailing Address
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Address Line | 6617 76TH AVE N
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City | BROOKLYN PARK
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State | MN
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Zip | 55428-1435
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Country | US
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Telephone | 763-260-7298
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Fax | 612-484-4413
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Authorized Official
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Title or Position | CEO
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Name | JAWAHIR AHMED
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Credential |
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Telephone | 763-260-7298
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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